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weaker and died at the end of the eleventh day, of day, and I trust they will all agree with me that to blood poisoning. With this case ended my diphthe- cure a case of malignant diphtheria requires faithful, ria cases and I think the last in the neighborhood systematic treatment. Be sure you have the best were in this family. I have only described my worst remedy or combination of remedies, use them thorcases, there were several milder where the membrane oughly, keep the patient under the influence of them was confined to tonsils and faucial membrane, the till you have the disease under control or till death is disease lasting from three to seven days.

certain. In all I had fifteen cases and two deaths. This does not include a single case but what had actual diph

Peritonitis. * theritic membrane extending at least over tonsils and faucial membrane. My treatment was Marchands

By X. O. Werder, M. D., PITTSBURGH, PA. hydrogen per. ox. used as a spray every two hours, and hydrorg. bi. chlor. from 0 to 20 grain every

While peritonitis, as a disease, was well known to two hours. Brandy I gave freely. Every patient physicians of all ages, a full knowledge of its patholwas fed on pineapple juice, fumes from burning sul

ogy and an intelligent method of treatment is clearly phur filled the sick chamber, and occasionally had a pa

the work of modern investigators. Its etiology, partient inhale the steam from slacking lime. The treat

ticularly, was very little understood until the phement was nearly the same in every case but the two reme

nomenal advances in abdominal surgery cleared the dies which were depended on and the ones which saved

darkness and threw light into the mysteries hidden in the lives of my patients were the peroxide of hydrogen

the abdominal cavity. Hand in hand with the surand the bichloride of mercury. The peroxide to des

geon worked the pathologist, and their combined troy the germs and keep them from multiplying, but

efforts brought about a revolution of our views of the of more importance still is the bichloride to eliminate

disease and its treatment. In no branch of medicine the poison from the system.

has such wonderful progress been made as in that I regard the bichloride the sheet anchor in the

pertaining to the peritoneum and the organs it intreatment of malignant diphtheria. It certainly mod

vests. It is true this progress has benefited surgery ifies the course of the disease, protects the kidneys

much more than medicine; so it appears that periand in many cases prevents membranous develop

tonitis, at least many of its forms, is rapidly becoming ment. In my fifteen cases and two deaths the mem

a surgical disease. The diagnosis of peritonitis does brane extended to the larynx in only one case (the

not satisfy the progressive mind of the modern physiten year old boy), while in the three cases and five

cian; he has learned the importance of striving to ardeaths of the other school in the same epidemic (and

rive at its cause and seat which, though contained in sometimes in the same house), where the bichloride

that large cavity invested by peritoneal membrane, was not used, the membrane extended to the larynx

may belong to any of the many organs located there. in all but two (and in one of these cases the bichloride

Peritonitis is, therefore, a general name for many diswas used at my suggestion and used freely). The

eases, differing not only in their symptoms, pathology quantity of bichloride given would average from They are only alike inasmuch as they are all accom.

and etiology, but frequently also in their treatment. to 12 grain in twenty-four hours for the first three to five days, or till the membrane began to loosen; from

panied by inflammation of the lining membrane of the that time the dose was gradually diminished, but

diseased organs, the investing peritoneum. never discontinued till all trace of the disease had

To enter into detailed description of all these forms disappeared. There was no diarrhæa resulting from

of peritonitis would be a task impossible to me withits use, the bowels generally moving once or twice

out transgressing the limits of my time. I therefore each day. Had no suppression of the urine, which

decided to confine my remarks to two large groups of fact was attributed to the use of mercury. I think

this disease which are by far the most frequent and the disease was prevented in some that were actually important, the one affecting with particular predilecexposed. Aged from six to fourteen years they were

tion the male sex, especially the younger portion of given the bichloride, and in the course of a week or ten

it; the other is exclusively a female disease. I refer days from date of exposure they all had all the symp

to perityphlitis or, more correctly, appendicitis and

pelvic peritonitis. toms of the disease except the membrane; they would recover in two to four days. I had a routine habit of

Formerly most inflammatory conditions in the right giving it to every one that had been exposed or was

iliac fossa were regarded as a typhlitis or perityphafraid of taking the disease; would give 0 gr. tablet

litis, the former being a catarrhal inflammation of the trit. after each meal to all over twelve years of age; to

mucous membrane of the cæcum, the latter an extenthose younger would give from one to two tablets

sion of this inflammation to its surrounding peritoeach day, and in many cases this medicine was taken

neal covering and especially of the retro-peritoneal regularly for two weeks. Although the bichloride

connective tissue of the cæcum, which was frequently was used freely by about seventy different persons,

accompanied by abscess formation in this retro-perilarge and small, there was not a single case of ptya

toneal tissue caused generally by perforation of the lism resulting from its use.

cæcum through its posterior wall. These collections In conclusion allow me to say. It is not all in the of pus were, therefore, thought to be outside of the remedies used; some credit must be given to the

peritoneal cavity. Disease of the appendix was much faithfulness in using it. A great list of diseases can

less connected with inflammation in the right illiac be treated on the expectant plan. Not so with the

fossa. Within the last few years our views have exdisease under consideration. This is one of the acute

perienced a decided change, principally influenced life destroying diseases in which proper medication

through the experience gained by the numerous aband diligence on the part of physician and friends

dominal sections made for this disease. Inflammawill certainly be rewarded with success. There are

tion of the cæcum or peri-typhlitis is now regarded as older and more experienced minds than mine here to- * Read before the Allegheny Med. Soc., Nov. 17, 1891.

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very rare, at least on the primary lesion, while ap- thing he complained of when he consulted me was pendicitis is extremely common.

McBurney says

inability to walk on account of stiffness and conthat in a hundred cases of inflammation in the ilio traction of the fexor muscles of the thigh. An excæcal region, ninety-nine are cases of appendicitis. amination revealed a deeply seated

mass in the An appendicitis may be a simple catarrhal inflam- right iliac fossa, tender on pressure. As this mass mation of the mucous membrane of the appendix ver in spite of rest and appropriate treatment, increased miformis, causing few or no symptoms, excepting, in size it was decided to operate. On the morning perhaps, some slight tenderness over the region, of the day set for operation he had a number of which may be easily overlooked, accompanied by stools containing evidences of pus, and the mass more or less disturbance of the digestive organs and had almost disappeared. The other case had two often some febrile symptoms. The appendix in such attacks of appendicitis within three months ; during cases generally contains small fecal concretions which the second of which the abscess ruptured into the act as irritants to the mucous surface and are accused bowel. In both this accident was followed by of bringing on the inflammatory trouble, though in rapid recovery. eight cases operated on by Lewis A. Stimson in only The disease may produce no symptoms outside one were there concretions of sufficient size to be of those of an ordinary indigestion, so long as it is justly blamed for the existing condition. Foreign confined to the mucous surface of the appendix. bodies, such as cherry pits, grape seeds, etc., are Severe symptoms point to a more violent inflammuch rarer the cause than was usually supposed, and mation not confined to the appendix alone. Such according to Jacobi it is probable that "few, if any cases may be ushered in by vomiting, and someforeign bodies enter the process unless the latter has times purging accompanied with severe pains, previously lost its elasticity and contractility by an particularly in the ilio-cæcal region ; the pulse is inflammatory change." This catarrhal inflammation accelerated, temperature often high, face anxious. may be followed by a complete resolution and perma On pressure we find tenderness over the seat of the nent cure, but in many cases frequent relapses occur. disease, the abdominal muscles over the region are The appendix may not be able to rid itself of these tense and rigid. Tympanites may

supervene. irritating fecal concretions, or the previous inflamma These symptoms may continue three or four days tion may have left a stricture at its cæcal orifice fol and then gradually subside. In many cases a tumor lowed by retention of its own secretion which may can be felt in the region of the appendix. If these give rise to renewed attacks of inflammation, espe symptoms continue unabated beyond the third or cially if excited by some traumatic influence. · This fourth day, especially if tympanites increase, the may not confine itself to the mucous membrane, but pains remain severe, the pulse becomes accelerated, extend to the submucous tissues and serous coat. the temperature rises to 102° or 103°, perforation and Lymph is thrown out over its neighboring structure formation of abscess may be looked for. Cases beand adhesions are formed encapsulating the original ginning with violent symptoms, intense pain, severe seat of disease, the appendix, and surrounding it by vomiting, marked tympanites, great tenderness in the a barrier intended by nature to protect the general ilio.cæcal region which papidly spreads over the peritoneal cavity, should ulceration and perforation whole abdomen, rapid pulse, are of the gravest result in the appendix.

nature and denote perforation into the general peritoAn abscess now forming would, contrary to olden neal cavity. A pulse of over 120 with rapid breathteachings, be intra-peritoneal, though not communi- ing, slight cyanosis, are extremely bad prognostic sympcating with the general peritoneal cavity ; loops of toms, as they are the expression of toxic effect on the intestines glued together may form the abscess wall action of the heart. and prevent general septic peritonitis and death. Frequently appendicitis does not have a typical The mass often felt in the right iliac fossa is noth course and its diagnosis may be very difficult. The ing else than this exudation surrounding the dis pain may be referred to other parts of the abdomen, eased appendix which may have become organized the cæcum being such a movable organ, that disinto a distinct abscess wall. When inflammation placement and change of position is not infrequent. and perforation come on suddenly and before nature Then again it may be disguised by other symptoms has time to protect the general peritoneal cavity by or complications, such as strangulation or obstrucsuch a provisional lymph-barrier, a violent septic tion of the bowels. Ransohoff reports twelve cases peritonitis is the result, with death in two or three in which appendicitis ran its course without any days. The autopsy of such a case I witnessed other symptoms than those of internal strangulation three or four months ago. The subject was a young, of the bowel. Hartly also reports two cases in which vigorous man who was taken severely sick with an operation was performed for internal strangula. peritonitis and died at the end of the third day. tion which proved to be intestinal obstruction from The whole abdominal cavity was in the condition adhesions to the wall of an abscess formed by a ganof septic inflammation; the appendix was perfo grenous appendix. It would therefore be well in all rated and sloughing, containing a cherry pit, and the obscure acute cases of abdominal troubles to keep in cæcum almost gangrenous and also perforated. In mind how frequently appendicitis bears a causative such cases there generally have been previous relation to many of these acute affections of the periattacks of appendicitis, though in this instance no toneum. In obscure cases “McBurney's point” may history of such could be obtained.

be of some diagnostic value. In McBurney's expeIf an abscess has formed the pus may find its rience in every case “the seat of greatest pain, deterway under the abdominal walls or into the retro mined by the pressure of one finger, has been exactly peritoneal tissues, or it may rupture into the gen between an inch and a half and two inches from the eral peritoneal cavity, or into an intestine. Within anterior superior spinous process of the ilium on a three months I have seen two cases with rupture into straight line drawn from the process to the umbilicus. the bowel. In one, a boy of sixteen years, the only This point indicates the base of the appendix where

He says

it arises from the cæcum, but does not demonstrate they are apt to be of the fatal cases. Further than that its chief point of disease is there."

this we should invariably operate as soon as the presThe large majority of cases of appendicitis recover. ence of pus is assured; when peritonitis is developing Statistics in regard to the mortality of the disease and spreading; when signs of sudden rupture of an differ greatly, however. It is a remarkable fact that abscess into the peritoneal cavity appear, and when German statistics show a much more favorable prog- septicæmia from septic absorption is taking place. nosis than those of America. Dr. Fred. Lange, of In children operation must often be done earlier than New York, thinks that either appendicitis in America in adults, as in them the malady is more speedy in is more fatal than in Germany or else the very severe development, more fatal in tendency and shows greatcases in that country do not go to the hospitals, from er proclivity to involve the general peritoneal cavity." which such statistics are derived.

" Ameri- (Thos. S. R. Morton, Philadelphia County Society, cans eat much, particularly concentrated food, masti- Sept. 28th, '91.) cate very little and suffer from constipation,” and are, Pelvic peritonitis is the most common form of peritherefore, particularly liable to this disease. Ren- toneal inflammation in the female. It is most frevers treated at the university clinic in Berlin, within quently localized with a tendency to remain so, and four years, fifty-four cases, of which three died. It is follows an essentially chronic course, with occasional also stated that out of 2,000 cases of inflammatory acute exacerbations. More so even than appendicitis conditions in the right iliac fossa in the German army, is it characterized by frequent relapses. One-third 96 per cent recovered without operation. Nothnagel of all gynæcological cases are victims of this disease. treated at his clinic in Vienna from 1889 to 1890, 65 Bande found residue of circumscribed peritonitis in cases, 55 men and 10 women, two-thirds of them be- more than half of all female cadavers, Winkel in tween the ages of 11 and 30 years, with a mortality of more than 33 per cent, A. Martin in 122 out of 287 three. Matterstock, however, gives out of 177 cases cases of tubal disease. 30 per cent mortality, of 70 children under 15 years, The cause of pelvic peritonitis, or perimetritis as it 70 per cent. Fitz in the “Transactions of the Associ- is also called, in a large majority of cases, is diseased ation of American Physicians," states that he ob- tubes. This is a fact which has only been learned served 72 cases, of which 74 per cent recovered and quite recently. Most inflammatory conditions in the 26 per cent died.

pelvis were thought to originate in the cellular tissue Simple cases of catarrhal appendicitis usually make and from there sometimes to invade the peritoneum; a speedy recovery under treatment by absolute rest cellulitis was, therefore, the primary and most imin bed, restricted diet, laxatives, particularly calomel portant disease. Not later than six years ago, Emor the salines, morphine, hypodermatically if abso- met, in the last edition of his work on Diseases of lutely required for pain, hot fomentations and possi- Women, says: “I shall employ the term "cellulitis" bly leeches. It is the severe forms that give the phy- in expressing the most common condition of pelvic sician greatest anxiety and tax his skill to the utmost. inflammation in connection with nonpuerperal diThe greatest difficulty is to decide when to interfere seases of women. Pelvic peritonitis will not be surgically. Unfortunately the symptoms are only too treated of as a distinct lesion, but as an accident, often unreliable guides; often when the symptoms in- rendering the case of cellulitis more grave in characdicate the necessity for operation the patient has al- ter from this complication." ready passed beyond the hope of relief.

The first description of the true pathology of pelvic Lewis A. Stimson says: “We have no means of inflammation was given us by Bernutz and Goupil distinguishing those cases which will go on to the for- over thirty years ago, who, by a careful examination mation of an abscess without accident from those in of ninety-nine cases, both during life and in the postwhich evolution will be gravely interrupted." He, mortem room, pointed out very clearly that it was not therefore, recommends early laparotomy (within the the cellular tissue which was involved in this inflamfirst three days) as it enables us to avert the process mation, but the peritoneum and that the cause of it by the removal of the cause, and regards it as less originated in the fallopian tubes.

originated in the fallopian tubes. Their teaching, dangerous than the expectant treatment. McBurney however, was entirely ignored until operative surgery states: “The pathological condition of the appendix has opened up the peritoneal cavity to daily exploraas compared with the symptoms in my own cases tions and found the conditions exactly as described by most positively show that one cannot with accuracy these investigators. The masses and indurations gendetermine from the symptoms the extent and severity erally found in the pelvis by bimanual examinations of the disease.” Mynter says: “That we are utterly and spoken of as exudations in the pelvic cellular tisunable to judge correctly from the symptoms alone of sue can be removed by the surgeon from the peritothe extent and severity of the appendix lesions and neal cavity; they do not involve the cellular tissue to for this reason alone abdominal section must be the any extent, but consist of ovaries and tubes folded safest method of treatment."

upon themselves, matted together by exudation and I believe that the advice of Thos. S. R. Morton, adherent to the posterior surface of the broad ligament who in connection with his father, Thos. G, Morton, of the uterus. Frequently we find also intestines and has devoted considerable attention to this disease, omentum or an appendix as a part of the tumor. and whose experience in the surgical treatment of Polk, in 1886, in a paper on the "study of sixteen this disease has been quite extensive, is not only good cases, of the so-called pelvic inflammation, known as but sufficiently conservative to meet the approval of ‘pelvic cellulitis,'” states that abdominal section was the nonoperative physician. It is, “to operate not made in all these cases and the lesions found were later than the third day of the disease, if the patient salpingitis, periovaritis and pelvic peritonitis. In two up to that time has failed to markedly improve, un- of ten cases there was slight ædematous swelling of der rest, restricted diet, purgation and topical appli- the cellular tissue in the broad ligaments, just beneath cations. Especially should this rule be adhered to the spot, at which an inflamed tube had rested; in the in cases where we have failed to move the bowels-- remainder the most careful examination failed to de

tect the slightest induration or swelling in any part of inal examination very painful. Within forty-eight the cellular tissue that lay about the uterus or between hours a swelling may be noticed on bimanual examithe layers of the broad ligaments."

nation, which in a few days may reach to the umbiliDr. N. C. Coe (Exaggerated Importance of Minor cus. It is at first soft, baggy, almost fluctuating, but Pelvic Inflammations) says: “Of half a dozen fatal gradually becomes firmer until it often appears as cases of hysterotrachelorrhaphy and incision of the hard as a board. cervix in which I enjoyed the rare opportunity of Under rest, opiates to relieve suffering, hot fomenstudying carefully the sequence, in every instance the tations and after the febrile symptoms have subsided, cause of death was acute diffuse peritonitis.” In re the iodides internally and tonics, and the local appligard to the more chronic cases to which circumscribed catien of iodine over the abdomen and to the vaginal areas of inflammatory exudations were found, he vault, hot douches, glycerine tampons, iodoform, states that “peritonitis is certainly the most promi- ichthyol, etc., the exudation gradually decreases unnent element in most of these cases, so far as the post til after a few weeks or months it has become impermortem appearances afford any light," and again " By ceptible. The patient's appetite has improved, her far the greatest number of these indurations are situ pains have lessened or disappeared entirely, she is ated high up in the broad ligaments and consist of gaining flesh and regards herself as cured. The incicatricial masses, mostly confined to the peritoneum flammation however, does not always run such a of tubes and ovaries surrounded by old adhesions or smooth course. Instead of ending in resolution it occasionally an imprisoned knuckle of intestine. I may go on to suppuration. Abscesses form and may confess that I have rarely (perhaps half a dozen times) discharge through vagina, rectum, bladder, abdominal found such thickening in the cadaver which could be walls, or intestines. They may then heal spontainferred to a pure and straightforward cellulitis, and neously, very rapidly or they may continue to discharge this, too, when I have recognized by the vaginal touch indefinitely, until the patient dies from exhaustion or (before and after death) what seemed to be an indu- sepsis, unless surgical measures are adopted. Even ration, a distinct band extending outward from a deep if the disease ends in resolution, this does not always laceration of the cervix or a condition of tension in or mean cure, on the contrary it is often followed by a above one lateral cul-de-sac, which did not exist on life of misery and suffering. When the patient rethe opposite side."

turns to her ordinary duties she finds that she is unJoseph Price, who has been in the abdominal cav able to fulfill them. She has aching in her back, abity oftener than any other American surgeon, says: dominal pains, increased on slight exertion, disturb" The operative gynæcologist does not find any pelvic ance of her gastric functions and other reflex sympcellulitis." Lawson Tait is equally emphatic on this toms. Her menses are more profuse than formerly subject.

and more painful, marital relations are accompanied Having established that cellulitis is a rare disease, with suffering or may have become utterly unbearable at least outside of the puerperium, and that what we in that, she presents the picture only too familiar to used to regard as such is in reality, in the large ma every physician practicing in gynæcology. Examinajority of cases, a pelvic peritonitis from the outset. tion reveals extreme tenderness over one or both We will now briefly inquire into the etiology of the uterine adnexa; perhaps some thickening in the latter. A diseased tube is usually the focus from region of tube and ovary; or you may find large which the peritoneal infection starts. Disease of masses in the region of tube and ovary and filling up the appendages may have preceded the attack of Douglas' point. In other words, while all active peritonitis for weeks or months, when a leaky tube peritoneal inflammation may have subsided, the focus may precipitate a peritonitis, that is, the secretion of the disease, the diseased appendages, have repent up in the tube may discharge through the ab mained and wait only a favorable opportunity to light dominal orifice of the tube into the peritoneal cavity up another acute pelvic peritonitis. I have seen as the result of hyperdistention, trauma, violent exer three and four such attacks within one year. Such tion, etc. Or the tubal disease may arise acutely and cases will probably go on from bad to worse until extend at once to the peritoneum, the most common these diseased appendages are removed. causes in producing inflammation of the uterine ad For the sake of convenience the results of pelvic innexa puerperal infection, gonorrhæa, extension of an flammation may be tabulated in five groups. endometritis to the tubal mucous membrane, a catch 1. Complete resolution and recovery. Such cases ing cold, especially during menstruation, etc. Un are restored to perfect health and are able to bear skillful intrauterine treatment, minor operations about children. the cervix, such as Emmet's operation, dilatation, 2. Adhesions about ovaries and tubes which, howetc., especially if done without the strictest antiseptic ever, do not affect the general health of the patient, precautions, are frequently followed by salpingitis but are frequently associated with sterility. and subsequently peritonitis ; the introduction of an Recovery with a catarrhal salpingitis and posunclean sound, especially if it produce a lesion to the sibly oöphoritis which under proper, but often promucous or muscular surface of the uterus, frequently longed treatment, improve and often get perfectly well. results in pelvic inflammation. The symptoms of 4. Includes cases of old and obstinate forms of pelvic peritonitis vary considerably in intensity, while salpingitis, hydrosalpinx and oöphoritis,who pass from often so mild as to escape our attention, its onset one physician to another, or from one quack to anmay, especially if due to a leaky pus tube, be so other and are doomed to permanent invalidism unless sudden, severe and violent as to resemble a peritoni relieved by the removal of the diseased organs. tis following perforation. The disease is usually ush 5th and last are principally the victims of grave ered in by a chill, fever, more or less severe pains in puerperal infection or gonorrhæa, suffering from the lower part of the abdomen, back and thighs, irri pyosalpinx and ovarian abscess, which are certainly tability of the bladder, sometimes rectal tenesmus. threatening their lives and are only curable by laparotThe hypogastric region is tender on pressure and vag omy.


In concluding this rather lengthy paper I make no act so promptly and well, and to which the entire sysclaims to originality or thoroughness in treating this tem seemed so responsive, as the arsenite of copper. important subject. I am well aware that it is merely Furred tongue and constipated bowels were readily a fragmentary exposition of the subject presented. relieved by giving calomel tablets, of one fourth grain Many points that seemed of particular importance to each, two or three times a day, giving two tablets at me have been dwelt upon rather in details while others a time.

In this way all cases of influenza, where the undoubtedly appearing equally or more important to nervous system and alimentary canal were attacked, some of you, I have only touched upon. Any omis- I treated with comfort to my patients and gratificasions in this paper will, without doubt, be supplied in tion to myself. I kept my patients strictly confined the discussion, which, I hope will be full and exhaus- to bed, allowing them to have the diet the appetite tive.

would take. The most agreeable article of diet I

found to be a fresh egg whipped up in a teacup and A Case of Meibomian Calculi.

the cup then filled with tea. This can be sweetened

or not, as the patient desires, and with a bit of toast A. W. BURROWS, M. D., Salt Lake City, Utah.

is generally as much as will be taken. This can be On may the 10th, 1891, I was requested to examine repeated three times a day with good effect, and treat the eyes of R. W. Stevens, a miner, æt about 45, whose eyes had troubled him for 34 years. Had taken treatment from innumerable persons both

PROCEEDINGS OF SOCIETIES. in and out of the profession, and had about exhausted the resources of them all and bankrupted the Materia ALLEGHENY COUNTY MEDICAL SOCIETY. Medica from ag noz to nace of different strengths in solution, to cocaine and hydrooxygen. Flav in ointments but at no time received any permanent relief.

Scientific Meeting, November 17, 1891. Upon examination I found in both superior and inferior pæpebral of each eye a symmetrical row of hard J. J. Green, M. D., PRESIDENT PRO TEM., IN THE CHAIR. whitish elevations which upon first sight I diagnosed "sago granulations,” but not yielding to ordinary DR. X. O. WERDER read a paper on PERITONITIS treatment I decided to cut down on one and upon do

which was discussed as follows: ing so I immediately encountered a hard substance, very difficult to extricate, which I found afterward was

Dr. Batten: I do not think I can say anything due to the shape, being somewhat starshaped. Here

new on the subject. The disease, however, is not so was something I had never read of or heretofore en

old as the reader would lead us to believe. The Italcountered, so putting on my thinking cap after vainly

ian physicians, in the latter part of the seventeenth and trying to get this one out with scoop and forceps for

the beginning of the eighteenth century, were the first an hour I determined as they were undoubtedly who gave some of the symptoms of the disease. They foreign bodies) to get them out. My plan of attack

studied the disease and made the diagnosis of periwas to instill four per cent solution of cocaine, hydro- tonitis. Cullen, in 1775, mentions the disease, but chlorate, then evert the lids and destroy the tissues does not describe it. Gast said, in 1809, that the deeply above and around each calculus with a pointed symptoms of the disease had been truly known for mitigated stick of nitrate of silver.

only twenty years, so that we did not have a true hisThe result was the removal of eighteen (18) calculi of tory of peritonitis until 1789. different sizes, from that of a mustard seed down, and

I have had two cases of the disease which he deof all shapes, excepting circular, some requiring a great scribes, that is, I suppose it would be classed under deal of patience, and the exertion of considerable that disease, pelvic peritonitis. It requires a good force at more than one sitting to remove, having been

deal of time to make out the disease. I remember in deposited so as to accurately mould themselves to the these two cases I attended, and I had a good diagnosconformation of the interior of the gland. I have six tician to see the cases with me, we were unable to or eight of them in my office for inspection which un- make out the disease until nearly the end of the secder the microscope look like quartz, but of course the

ond or third week. One case, however, went on and molecules are not possessed of as much cohesion and an abscess was formed and opened and the pus let out they crumble rather easily under pressure. Result of and the patient recovered. In regard to the existence operation: perfect relief.

of these diseases, I have no doubt they exist a great deal more frequently than we have any idea of or

even suspect, and a great many patients likely to go Arsenite of Copper for La Grippe.

on without any treatment whatever, or any successful

treatment, and remain as invalids the remainder of J. B. Johnson, M. D., Washington, D. C.

their lives if they do not come in contact with some In the influenza epidemic of the past winter and one who can make out a proper diagnosis. early spring, of course I had my share of cases to Dr. Macfarlane: I listened with a great deal of treat. It presented itself to me, as to other physi- pleasure to the doctor's paper. While septic peritocians, in all its protean forms, yet I was always careful nitis is more common than the majority of the profesto ascertain in each case I treated whether the malady sion appreciate, possibly owing to inability to diagwas confined in its most marked form to the nervous nose it, I think very many medical men recognize system, alimentary canal, or to the respiratory organs. trouble about the appendix, even though no tumor In all cases in which the most prominent symptoms can be found in the region. I think sometimes the were of a nervous character, attended with severe trouble is referred to the appendix, mistakingly. Still headache, and also those in which the alimentary the matter is, of course, more or less common. About canal was most implicated, I found no medicine to the location of the appendix, by the aid of McBurney's

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